Case 1
A 79-year-old male with severe aortic stenosis (AS) underwent AVR using
a 23-mm, first-generation Trifecta valve in September 2015. Three years
later, the patient presented with congestive heart failure, class III
NYHA dyspnea, and severe aortic regurgitation (AR). After treatment for
heart failure, platelets decreased to 10,000/μl, and idiopathic
thrombocytopenic purpura was diagnosed, later found to be caused by
Helicobacter pylori that was subsequently eradicated using antibiotics
plus a proton pump inhibitor. Oral prednisolone and thrombopoietin
receptor agonist were given two months before surgery to treat immune
thrombocytopenia, with levels rising to 90,000/μl after treatment. An
AVR using a 25-mm Inspiris Resilia aortic valve (Edwards Lifesciences
LLC, Irvine, CA, USA) and a graft replacement of the ascending aorta
with a 30-mm Dacron tube graft was performed. Intrasurgical findings
revealed two leaflet tears at the bottom of the left coronary cusp and
at the parastent part of the non-coronary cusp (fig.1). Recovery was
uneventful and discharge occurred without any complications.